Residential Property Disclosure Form

Today's Date

Date

Property Legal Description

Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

In accordance with the law, a seller/owner must provide a property disclosure document to the buyer. This is a right of the buyer and the transaction can be canceled or terminated if the seller/owner wasn't able to provide one. Failure to provide one can lead to legal actions or suspension.
The owner/seller must provide honest, accurate, and detailed information about the condition of the property. The purchaser/buyer has the right to request a home inspection process and analysis in order to make sure that the property is in good condition.
The owner/seller is not claiming any accurate details on whether the property affects any historic district ordinance. The purchaser/buyer should do what is necessary to follow and preserve historic district ordinances.
The owner/seller is not claiming any accurate information about whether the property contains resource protection areas. The purchaser/buyer should do what is required to determine whether the property affects any resource protection area when reviewing the official local map.
The owner/seller is not claiming any accurate details if the property will be affected if the dam breaks. The purchaser/buyer should review if it will be affected or not.
The owner/seller is not claiming that he/she is responsible for the wastewater management system in terms of maintenance and repairs. The purchaser/buyer should be responsible in terms of inspecting the system including maintenance and repair.
It is the duty of the purchaser/buyer to review if the property is in the special flood hazard area and has the right to obtain any related documents or certificates.
The owner/seller is not claiming any accurate information whether the property does not meet the Safe Drinking Water Act which should be lead-free. The purchaser/seller should be responsible for making sure that this is not the case.
The purchaser/seller should also review or request for a radon gas inspection and the owner/seller is not claiming any accurate information if the property is radon gas-free.

How long have you owned the property?

What is the lot size?

Are you aware of the following rights?

Rows	Yes	No
Timber rights	1	2
Right of ingress or egress	3	4
Right of way	5	6
Right of access	7	8
Servitude of passage	9	10
Servitude of drainage	11	12
Air rights	13	14
Surface rights	15	16
Mineral rights	17	18
Common driveway	19	20

Was any part of the property painted prior to 1978? If yes, please make sure that it is not using lead-based paint.

Are there any cracking or visible problems in the foundation of the property structure?

Have there been any installation or major alterations in the property?

Is the owner/seller aware of any violates of building or zoning codes/regulations?

What is the type of the source of water?

What is the sewage system?

Utilities

Rows	Condition	Remarks
Heat Energy source
A/C Energy Source
Water source
Electricity source
Drainage
Sewer/Plumbing

Was any part of the roof repaired or replaced?

Are there any known leaks in the roofs or walls?

Are there any termites, pests, or wood-destroying organisms in the property?

During the ownership of the seller, was there any insurance claims?

Are there any hazardous or toxic materials in the property?

Are there any landfills, graves, or wells near the property?

Are there any hidden defects that the purchaser/buyer should be aware of? If yes, please explain below:

Kindly indicate the name of the items that will remain with the property? (e.g appliance, home media, interior fixtures etc.)

By signing below, the owner/seller acknowledges this document and understands his/her rights and obligations under the law.

Owner's/Seller's Name

First NameLast Name

Owner's Signature

Date Signed

Date

By signing below, the purchaser/buyer acknowledges this document and understands his/her rights and obligations under the law.

Purchaser's/Buyer's Name

First NameLast Name

Purchaser's Signature

Date Signed

Date

Residential Property Disclosure Form

Disclosure Statement

Acknowledgment